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• W1970896295 abstract "Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women and affects 7–14% of women of reproductive age worldwide (de Groot et al, 2011de Groot P.C.M. Dekkers O.M. Romijn J.A. Dieben S.W.M. Helmerhorst F.M. PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis.Hum. Reprod. Update. 2011; 17: 495-500Crossref PubMed Scopus (263) Google Scholar). PCOS is a rather heterogeneous condition characterized by clinical and/or biochemical androgen excess, ovulatory dysfunction and polycystic ovaries (PCO) (Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group, 2004Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop groupRevised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).Hum. Reprod. 2004; 19: 41-47Crossref PubMed Scopus (4588) Google Scholar). As the new diagnostic criteria specify that the presence of at least two of these criteria is required, the syndrome includes four broad phenotypes: (i) patients with hyperandrogenism, oligoanovulation, and PCO (full-blown syndrome), (ii) patients with hyperandrogenism and oligoanovulation (non-PCO PCOS), (iii) patients with hyperandrogenism and PCO (ovulatory PCOS), and (iv) patients with oligoanovulation and PCO (nonhyperandrogenic PCOS) (Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group, 2004Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop groupRevised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).Hum. Reprod. 2004; 19: 41-47Crossref PubMed Scopus (4588) Google Scholar). The influence of PCOS on female reproduction ranges from anovulatory infertility to adverse effects on oocyte quality (Liu et al, 2010Liu S. Jiang J.-J. Feng H.-L. Ma S.-Y. Li M. Li Y. Evaluation of the immature human oocytes from unstimulated cycles in polycystic ovary syndrome patients using a novel scoring system.Fertil. Steril. 2010; 93: 2202-2209Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, Patel, Carr, 2008Patel S.S. Carr B.R. Oocyte quality in adult polycystic ovary syndrome.Semin. Reprod. Med. 2008; 26: 196-203Crossref PubMed Scopus (49) Google Scholar), embryo quality (Kodama et al, 1995Kodama H. Fukuda J. Karube H. Matsui T. Shimizu Y. Tanaka T. High incidence of embryo transfer cancellations in patients with polycystic ovarian syndrome.Hum. Reprod. 1995; 10: 1962-1967PubMed Google Scholar), endometrial receptivity (Bellver et al, 2011Bellver J. Martínez-Conejero J.A. Labarta E. Alamá P. Melo M.A.B. Remohí J. Pellicer A. Horcajadas J.A. Endometrial gene expression in the window of implantation is altered in obese women especially in association with polycystic ovary syndrome.Fertil. Steril. 2011; 95 (2341.e1–2341.e8): 2335-2341Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar), and pregnancy outcomes (Kjerulff et al, 2011Kjerulff L.E. Sanchez-Ramos L. Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a metaanalysis.Am. J. Obstet. Gynecol. 2011; 204: 558.e1-558.e6Abstract Full Text Full Text PDF PubMed Scopus (191) Google Scholar). The high incidence of obstetric and neonatal complications among PCOS women is shown to vary widely according to different PCOS phenotypes (Palomba et al, 2010Palomba S. Falbo A. Russo T. Tolino A. Orio F. Zullo F. Pregnancy in women with polycystic ovary syndrome: the effect of different phenotypes and features on obstetric and neonatal outcomes.Fertil. Steril. 2010; 94: 1805-1811Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar). Therefore, it is of clinical importance to understand the impact of each PCOS condition on female reproduction, pregnancy establishment and later outcomes. Nevertheless, despite the tremendous research efforts directed at understanding PCOS, the mechanisms of this syndrome are still only partially understood (Ben-Shlomo, Younis, 2014Ben-Shlomo I. Younis J.S. Basic research in PCOS: are we reaching new frontiers?.Reprod. Biomed. Online. 2014; 28: 669-683Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar). In this issue of RBMOnline, Palomba et al, 2014Palomba S. Falbo A. Chiossi G. Tolino A. Tucci L. La Sala G.B. Zullo F. Early trophoblast invasion and placentation in women with different polycystic ovary syndrome phenotypes.Reprod. Biomed. Online. 2014; https://doi.org/10.1016/j.rbmo.2014.04.010Abstract Full Text Full Text PDF Scopus (40) Google Scholar investigates the early trophoblast invasion and placentation in distinct PCOS phenotype groups. In previous studies it was shown that impaired decidual trophoblast invasion and defects in placentation relate to pregnancy complications associated with PCOS (Palomba et al, 2012Palomba S. Russo T. Falbo A. Di Cello A. Amendola G. Mazza R. Tolino A. Zullo F. Tucci L. La Sala G.B. Decidual endovascular trophoblast invasion in women with polycystic ovary syndrome: an experimental case-control study.J. Clin. Endocrinol. Metab. 2012; 97: 2441-2449Crossref PubMed Scopus (68) Google Scholar, Palomba et al, 2013Palomba S. Russo T. Falbo A. Di Cello A. Tolino A. Tucci L. La Sala G.B. Zullo F. Macroscopic and microscopic findings of the placenta in women with polycystic ovary syndrome.Hum. Reprod. 2013; 28: 2838-2847Crossref PubMed Scopus (61) Google Scholar). In fact, in those studies, Palomba et al. demonstrated for the first time that pregnant patients with PCOS have abnormalities in decidual endovascular trophoblast invasion, and that specific PCOS features, such as hyperandrogenism and insulin resistance, seem to be the main factors contributing to this alteration (Palomba et al, 2012Palomba S. Russo T. Falbo A. Di Cello A. Amendola G. Mazza R. Tolino A. Zullo F. Tucci L. La Sala G.B. Decidual endovascular trophoblast invasion in women with polycystic ovary syndrome: an experimental case-control study.J. Clin. Endocrinol. Metab. 2012; 97: 2441-2449Crossref PubMed Scopus (68) Google Scholar). An additional contribution of their study was to show that the morphology and microscopic structure of the placenta in those PCOS patients who had an uncomplicated pregnancy was altered when compared with the placental structure in healthy controls (Palomba et al, 2013Palomba S. Russo T. Falbo A. Di Cello A. Tolino A. Tucci L. La Sala G.B. Zullo F. Macroscopic and microscopic findings of the placenta in women with polycystic ovary syndrome.Hum. Reprod. 2013; 28: 2838-2847Crossref PubMed Scopus (61) Google Scholar). As PCOS is a very heterogeneous syndrome, it is reasonable to believe that the placental developmental events differ among distinct PCOS phenotypes. However, these events have not yet been studied. With their new elegantly designed study on homogenous patient groups of the four PCOS phenotypes, Palomba et al. demonstrate that early trophoblast invasion and placentation is altered in patients when compared with healthy controls, but differs between distinct PCOS phenotype groups (Palomba et al, 2014Palomba S. Falbo A. Chiossi G. Tolino A. Tucci L. La Sala G.B. Zullo F. Early trophoblast invasion and placentation in women with different polycystic ovary syndrome phenotypes.Reprod. Biomed. Online. 2014; https://doi.org/10.1016/j.rbmo.2014.04.010Abstract Full Text Full Text PDF Scopus (40) Google Scholar). Thus, the rate of implantation site vessels with endovascular trophoblast invasion, as well as the extension of that endovascular trophoblast invasion, were significantly lower in PCOS patients when compared with controls. Furthermore, in delivered placentas, both the macroscopic (placental weight, thickness, volume, density, irregular shape) and microscopic data (placental villous surface/volume/space, thickness of stem villi arterial walls, extension of fibroids, and mitotic activity) were all altered when compared to controls. In all four PCOS phenotype groups the trophoblastic and placental characteristics measured were altered, but the highest rate of abnormalities was detected in patients with full-blown and non-PCO phenotypes, suggesting the importance of the role played by hyperandrogenism and ovarian dysfunction. These findings are in line with previous studies, in which increased risk for adverse obstetric or neonatal outcomes was observed in exactly these phenotypes (Falbo et al, 2010Falbo A. Rocca M. Russo T. D'Ettore A. Tolino A. Zullo F. Orio F. Palomba S. Changes in androgens and insulin sensitivity indexes throughout pregnancy in women with polycystic ovary syndrome (PCOS): relationships with adverse outcomes.J. Ovarian Res. 2010; 3: 23Crossref PubMed Scopus (43) Google Scholar, Palomba et al, 2010Palomba S. Falbo A. Russo T. Tolino A. Orio F. Zullo F. Pregnancy in women with polycystic ovary syndrome: the effect of different phenotypes and features on obstetric and neonatal outcomes.Fertil. Steril. 2010; 94: 1805-1811Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar). In addition, PCOS patients with complicated pregnancy showed higher serum androgen levels and insulin sensitivity indexes (Falbo et al, 2010Falbo A. Rocca M. Russo T. D'Ettore A. Tolino A. Zullo F. Orio F. Palomba S. Changes in androgens and insulin sensitivity indexes throughout pregnancy in women with polycystic ovary syndrome (PCOS): relationships with adverse outcomes.J. Ovarian Res. 2010; 3: 23Crossref PubMed Scopus (43) Google Scholar). In their current study, Palomba et al. also detect that these two phenotype groups have hyperandrogenaemia and raised insulin resistance markers, and they suggest that these two factors are the main determinants of the effects of PCOS on trophoblastic and placental tissue. However, the exact mechanisms by which hyperandrogenaemia and insulin resistance might exert their effects on early trophoblast invasion and placental alterations are so far unknown. One has to bear in mind the complexity of these types of studies, where human placental development and mechanisms are investigated. Thus for ethical, technical and medical reasons, placental analysis is limited to two periods (i) up to 12 weeks of pregnancy, and (ii) following delivery. These, in fact, are the two time points in the Palomba et al. study, at which trophoblast and decidual tissue and delivered placentas were collected and analysed. Thus, the direct relationship between trophoblast and placental alterations and obstetric outcomes cannot be investigated. The strength of their study is their use of homogenous, and relatively large, age-and-body mass index control-matched study groups (including those of the rarest PCOS phenotypes). The current study is well designed and sufficiently powered, as is often not the case in many experimental studies, so that the results can be interpolated and solid conclusions can be drawn. This study by Palomba et al. provides new insights into the complex and heterogeneous disease of PCOS. The high heterogeneity observed among PCOS patients in terms of hormonal and metabolic profiles seems to have relevant implications during the early stage and late placental development. The study unquestionably highlights the need to completely evaluate the PCOS phenotypes in clinical as well as scientific settings. This novel study is just the beginning of the processes of highlighting how different PCOS phenotypes have distinct effects on female reproductive outcomes. It will be for future studies to unravel the different aetiologies of distinct PCOS phenotypes." @default.
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• W1970896295 title "New insights into the complex disease of PCOS: findings from early trophoblast invasion and placentation" @default.
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